Francis Story The Search for the Self

The search for Self is vain, because it is a search for something that does not exist except as a mythical concept which has had to be taken into the structure of language by common assent. If it is used in any other way than as a fictitious convenience - if it is taken as meaning something real and enduring - it cannot be anything but a stumbling-block to the development of right understanding.

Friday, September 15, 2006

Failure of the Government's 'Alcohol Harm Reduction Strategy'

From Lord Avebury P0615091

Tel 020-7274 4617Email ericavebury@gmail.com

September 14, 2006

Dear Tony,

Thank you for your letter of September 7 about the Government’s approach to alcohol misuse. You don’t mention my letter to the Home Secretary of June 25, in which I asked him about his plans for compulsory rehabilitation of drinkers who commit violent crimes, reported in The Observer of June 25, and I enclose a copy for ease of reference. It would be much appreciated if I could have an answer, particularly as the targeted screening and brief interventions, and the possible dedicated referrals for offenders you now refer to in your current letter would increase the demand for alcohol rehabilitation services.

The Government had made no additional funding available to the NHS for this purpose under the Alcohol Harm Reduction Strategy, and the £15 million extra you now say is available to Primary Care Trusts from 2007/08 on top of the present £217 million, a mere 6.9%, would represent a trivial increase in real terms after taking into account wage inflation. How much of the £15 million do you estimate is required for the targeted screening and brief interventions, or is there some other money for that purpose? What are the ‘new initiatives to help people who are damaging their health through alcohol abuse’, and do you really think £3.2 million is a sum proportionate to the cost of misuse to society? Is any of the £15 million or the £3.2 million going to be earmarked for services to prisoners, a high proportion of whom are serving sentences for crimes that are connected with alcohol misuse?

On the taxation of alcohol, you repeat the mantra that the Government does not regard this, by itself, as an adequate way to deal with alcohol abuse. Nobody has ever suggested that taxation should be the only means of dealing with the problem, but I certainly challenge your ex cathedra assertion that other instruments such as social legislation and self-regulation are more effective. What evidence do you have for that statement? If the aim is to reduce consumption – and this paragraph of your letter now appears to accept this objective – the social legislation required might have to be quite drastic, as in Finland, for example, and I suggest it would be far more difficult to persuade the British electorate to accept Scandinavian-type restrictions on alcohol, than to apply the price mechanism which they have been used to in previous years.

The Advisory Council on the Misuse of Drugs has now weighed in with a recommendation that it would be irresponsible to reject. They show that alcohol consumption rose by 20% between 1998 and 2002, from 9.7 to 11.7 litres of pure alcohol per person per year [Pathways to Problems, para 2.26], while among young people aged 16-19, the proportion of males drinking over 50 units a week increased by 80% between 1992 and 2002, and of females, the increase was 400% {para 2.29]. The ACMD say that ‘there is very strong evidence that increasing the price of alcohol reduces consumption overall and may have a disproportionately large effect on consumption by young people’. They recommend that the Government should seriously consider progressively raising the excise duty on alcohol, and this has to mean that it should be raised by an amount sufficient to make alcohol expenditure form a higher proportion of people’s average disposable incomes. What is your answer to their evidence-based proposal?

I am interested to learn that DH officials have participated in working groups preparing the European Union Alcohol Strategy which is to be published next month, but what policies have we been recommending to our EU partners? Will you please lodge copies of the papers we have presented at these working groups in the Library of the House of Lords?

In my letter of July 1, I drew attention to the evidence in the IC Report that the alcohol problem is worse in some other EU member states than in Britain, and suggested that European policy should be to align duties on alcohol upwards throughout Europe. May I please have your comments on that proposal?

From the statistics available to the ACMD, the Government’s Alcohol Harm Reduction Strategy has not achieved the long term aim of reducing the harms caused by alcohol, and as you know perfectly well, ACPO has said that it is far too early to say whether the extension to the licensing hours has had a positive or negative impact on crime and disorder. It is therefore quite unjustifiable for you to couple the reductions in alcohol-related violent crime figures with the Licensing Act, as you do in your final paragraph. Please take heed of the admonition by Chris Allison, ACPO lead on Licensing, in the Press Release, Reference 109/06 of August 2, 2006, ‘ACPO LINE ON THE LICENSING ACT’, that ‘it will be at least a year before we can measure the true impact of the Act, and stop making any claims until you have the evidence.

I did ask the Home Secretary, in my letter of August 2, copy also attached for the web reference of the site where the parameters to be used in the assessment of five areas in which extensions of hours had been granted, and five other control areas in which the hours are unchanged, are being recorded, and I repeat this request.

You say that it would not be practicable to replicate the detailed analysis of the Cabinet Office’s Interim Analytical Report on an annual basis, as I suggested (not for the first time) in my letter of August 2, copy also attached. On what other basis do you suggest that the public might assess the overall success of your Alcohol Harm Reduction Strategy? Rather than focusing entirely on binge drinking, on which, I reiterate, the ACPO jury is out, lets take the Information Centre for Health and Social Care’s statistics on hospital admissions where there was either a primary or a secondary diagnosis of selected alcohol-related disease as a representative index of alcohol-related harm, referred to in my letter of July 1, but on which you make no comment. [www.ic.nhs.uk/pubs/alcoholeng2006/alcoholstatsncopyright/file, Statistics on alcohol, 2006, the Information Centre, June 30, 2006, Table 5.2, p 51] This figure increased from 88.6 thousand in 2000/01 to 126.3 thousand in 2004/05, an increase of 44.25%, and if the cost of alcohol harm went up by that amount since the Interim Analytical Report, it would now have reached £28.5 billion. The outcome of your Government’s so-called Alcohol Harm Reduction Strategy would be an increase in the level of harm costing the nation £8.5 billion. I am sure you will have arguments to show that hospital admissions cannot be taken as an index of alcohol harm, but if that is your case, you have an obligation to construct a representative index that will allow the public to judge the success or failure of your policies. Please do so.

Thank you for your letter of July 19 about your intended programme of Home Office reforms, based on six key priorities.

I note that you intend to concentrate especially on drugs-related crime, and I wonder if that includes alcohol-related crime? As you will no doubt recall, the Cabinet Office’s Interim Analytical Report for the National Alcohol Harm Reduction Strategy of September 2003 estimated that the crime/public disorder costs of alcohol misuse then amounted to £7.3 billion a year, but since, as that Report pointed out, alcohol is widely associated with socialising, relaxing and pleasure, we are reluctant to adopt measures that would interfere with excess consumption. If people drink too much, and then behave in ways that are dangerous to themselves and others, we pick up the pieces half-heartedly, but deliberately avoid tackling the underlying problem. Thus your reform programme mentions alcohol twice: first, in the context of a visit by Patricia Scotland to an existing Drug and Alcohol Treatment Service, and second, where reference is made to the continuation of work with other Departments. There is also a photograph of you with a police officer in Soho, which implies an interest in the phenomenon of late night binge drinking, but nothing more.

The lack of any effective intention to reduce alcohol harm is exemplified by the Government’s failure to update the estimates in the Strategy Unit report, including not only the crime and disorder figure, but the whole of the £20 billion worth of harm to society. If you were genuinely embarking on a programme to reduce this appalling figure, the first thing you would do would be to provide periodic statistics so that you and the public could measure the success of the policies you adopt. In respect of the Licensing Act, it was agreed after a lot of pressure that a ‘robust methodology’ (Patricia Scotland in a letter to me of August 24, 2005) would be used to assess the effects of the Act in five areas where extensions of hours were granted, matched with five areas in which the hours were unchanged. I could find no mention of this assessment on the Home Office website and would be obliged if you could let me have the URL. As a ‘valued partner of the Home Office’ I would also be grateful for replies to my two previous letters on alcohol-related harm, dated June 25 and July 1, copies of which are attached for ease of reference.

Further to my letter of June 25 about alcohol harm, may I please draw your attention to the enclosed BBC item on the report published yesterday by the Information Centre for health and social care (IC), and on the comments made by several experts on the figures.

These alarming figures relate to a period before the Licensing Act came into operation. But it is generally acknowledged that the reason for the increase in harm caused by alcohol is that, as Professor Ian Gilmore says, the stuff is too inexpensive and readily available.

A genuine alcohol harm reduction strategy would not be concerned predominantly with picking up the pieces afterwards, but reducing the consumption of a substance that your own research showed was already causing £20 billion worth of harm in 2000. This report shows that alcohol consumption per capita increased further between 2000 and 2002 (Table 2.17), and that the mean alcohol consumption by secondary school children increased slightly between 2000 and 2005 (Table 3.2). Alcohol-related deaths increased between 2000 and 2004 (Fig 5.2), and hospital admissions where there was either a primary or secondary diagnosis of selected alcohol-related disease increased from 88.6 thousand in 2000/01 to 126.3 thousand in 2004/05 (Table 5.2)

The amount of alcohol-related harm must certainly have increased markedly since the Cabinet Office’s Interim Analytical Report, which produced the figure of £20 billion related to 2000. Why is the Government not willing to produce an annual update of that analysis? Is it because you want to conceal the extent of the strategy’s failure?

The IC report shows that the problem is even worse in some other EU member states. We should seek to align the duties on alcohol upwards throughout the EU, to reduce the harm suffered by all European citizens, and to ensure that differences in alcohol pricing between member states are not an encouragement to smugglers.

An effective strategy for combating alcohol-related harm would mean better coordination between the Home Office, DCMS, ODPM, DH, DEFRA, the FCO and the Treasury. This strategy would not deal only with binge drinking, just because it’s the most noticeable aspect of the problem, but would set out to reduce all dangerous drinking, which affects many more than the highly visible young people vomiting, fighting and passing out in city centres.

Nearly one in four secondary school children aged 11-15 reported that they had drunk alcohol in the past week when surveyed in 2005.

The average amount of alcohol consumed by this age group doubled between 1990 and 2000 and currently remains at 10.4 units (or about 10 small glasses of wine or five pints of beer) per week.

Young adults are the most likely to binge drink - a third of men and a quarter of women aged 16-24 said they had drunk more than double the recommended number of units on one day of the previous week, typically Saturday, when surveyed in 2004.

Rising consumption

In comparison, older adults, aged 45-64, are more likely to drink smaller amounts regularly, on five or more days of the week.

The report also looked at the alcohol consumption levels of the European Union countries, with the UK's four home nations ranked as a group.

Although high, the UK's consumption levels ranked middle against other European Union countries in 2001. Luxembourg topped the table, with its residents drinking an average 17.54 litres per capita per year compared to the UK's 10.39 litres.

But unlike other countries in Europe, the UK's alcohol consumption is still rising. There are serious concerns about the impact of this across the UK.

Professor Denise Lievesley, Chief Executive of The Information Centre, said it was important not to underestimate the effect of alcohol on health.

"By presenting this data we hope that health professionals will be better equipped to put their work in context and to raise awareness of the dangers of alcohol misuse," she said.

Anne Jenkins of Alcohol Concern said the statistics presented "compelling evidence of the devastating impact of excess drinking on the nation's health."

She added: "In 2004, the government laid out a national strategy for tackling alcohol misuse. These statistics underline the need for a major push for the government to meet the targets it set itself."

Regulation

Professor Ian Gilmore of the Royal College of Physicians said: "Whilst today's figures are shocking they are not really surprising."

He questioned whether current measures to reduce alcohol misuse were enough.

"There is going to be a need for regulation. The drivers of alcohol-related health problems are price and availability."

He said alcohol was too inexpensive and readily available in supermarkets around the clock.

A Department of Health spokesperson said: "We know that alcohol misuse has a devastating effect on millions of lives each year. And that is why we are working with the drinks industry, police and health professionals to increase awareness of the dangers of excessive drinking and make the sensible drinking message easier to understand.

"We will also be launching a joint campaign with the Home Office later this year to promote sensible drinking amongst young people."

Shadow Health Secretary, Andrew Lansley, said the figures were deeply concerning. "The government's failure to adequately address binge drinking, and ill-thought though 24 hour licensing policy will do nothing to help the situation," he added

"The government must start to prioritise public health and not cut back on rolling out programmes because of deficit problems."

Story from BBC NEWS:http://news.bbc.co.uk/go/pr/fr/-/1/hi/health/5132856.stm

If The Observer reported you accurately on drinkers who commit violent crimes being forces to undergo rehab treatment, where are you going to find the places?

You say there is no evidence that the extension of drinking hours led to an increase in drink-related crime, and I would be grateful if you could let me know what evidence you have looked at. Since the Government has decided to compare the incidence of crimes of violence against the person, and ambulance call-outs, on or in the vicinity of licenced premises, over a period of a year before and after the Act came into force, you haven’t yet got the figures.

Surely the way to deal with alcohol-related crime is to persuade drinkers to reduce their consumption of alcohol, rather than to pick up the pieces after they have committed offences. Can you point to any measures the Government have taken to reduce drinking?

Presumably the Government take no responsibility for the behaviour of British football fans, who cause trouble everywhere they go in Europe. But they have got into the habit of drinking too much in England, so they do the same when in Stuttgart or wherever. That is the most visible product of successive governments’ failure to develop a genuine and effective alcohol harm reduction strategy, and there are plenty of others, adding up to the £20 billion damage caused in the year 2000, according to the Cabinet Office.

Please don’t tinker with compulsory rehab, but do something positive to combat alcohol harm. Ask Gordon Brown to raise alcohol duties and thus reduce drinking, and campaign for other EU member states to do the same.

Drinkers who commit violent crimes could be forced to undergo rehab treatment, the Home Secretary suggested yesterday amid warnings from senior police officers about the impact of relaxing drinking laws.

John Reid said he was considering whether the fast-tracking of drug addicts into detox to stop them reoffending could be extended to those who offended when drunk. On a visit to police on night duty in Soho he was told by Commander Chris Allison, the Association of Chief Police Officers spokesman on licensing, that he still had 'concerns' about the relaxation in licensing laws.

Reid said there was no evidence that the change had increased drink-related crime as some had predicted, but that he was considering ways of tackling the causes of violence, including drinking. He endorsed schemes to stop addicts reoffending to get money for drugs, and added: 'We don't at the moment have anything similar to that on alcohol but if the drugs intervention proves worthwhile, then we can look at the other driver of violent crime.'

About 40 per cent of crime is thought to be alcohol-related: the arrest of 122 British fans in Germany yesterday drew attention back to British drinking.